| NPI | 1760101299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: WI 23549330) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WI 235493-30) |
| Enumeration Date | 2022-08-26 |
| Last Update Date | 2022-10-07 |